Healthcare Provider Details

I. General information

NPI: 1316137060
Provider Name (Legal Business Name): JOSEPH W TUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 09/20/2022
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SOUTH RD
FARMINGTON CT
06032-2483
US

IV. Provider business mailing address

263 FARMINGTON AVE PROVIDER ENROLLMENT
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-1440
  • Fax: 860-679-6465
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046663
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number046663
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: